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High-Sensitivity Troponin I and Amino-Terminal Pro-B–Type Natriuretic Peptide Predict Heart Failure and Mortality in the General Population
Study Questions:
What is the prognostic utility of a novel cardiac troponin I (cTnI) high-sensitivity assay, independently and in combination with amino-terminal pro–B-type natriuretic peptide (NT-proBNP), to predict development of heart failure (HF) in the future and mortality in the general population?
Methods:
The study cohort was comprised of 2,042 participants who underwent clinical assessment and echocardiographic evaluation. The investigators obtained baseline measurements of cTnI with a high-sensitivity assay and NT-proBNP in 1,843 individuals. The study investigators followed participants for new-onset HF and mortality, with median (25th, 75th percentile) follow-up of 10.7 (7.9, 11.6) and 12.1 (10.4, 13.0) years, respectively.
Results:
The study investigators found that the high-sensitivity cTnI greater than the gender-specific 80th percentile was independently predictive of HF (hazard ratio [HR], 2.56; 95% confidence interval [CI], 1.88-3.50; p < 0.001) and mortality (HR, 1.91; 95% CI, 1.49-2.46; p < 0.001) beyond conventional risk factors, with significant increases in the net reclassification improvement for HF. Although the prognostic utility of high-sensitivity cTnI went beyond NT-proBNP, the findings of this study suggest that these two assays are complementary and most helpful when evaluated together in identifying at-risk individuals for HF.
Conclusions:
The authors concluded that the utility of high-sensitivity cTnI can be used together with other biomarkers to aggressively prevent HF in the general population.
Perspective:
This is an important study because it suggests that high-sensitivity cTnI can add incremental value to measurements of NT-proBNP in predicting HF. The findings of this study now need to be validated in the general population, including the elderly and individuals from multi-ethnic backgrounds.
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